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Authorization:

By entering the bank account information herein, you hereby confirm that you provide authorization for Skyline Insurance Agency to use the above payment method for payment of the policy being applied for, and that the insurance company is authorized to initiate payments from the bank account that you are hereby submitting for premium payments as they become due. Premiums due include but are not limited to premium, policy fees, inspection fees, installment fees or any applicable fees.

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Document name: EFT Authorization

Unique Document ID: bd605da4c07fef4fd3f2cbc711db0c32c2752790

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Timestamp	Audit
February 15, 2024 8:42 am MDT	EFT Authorization Uploaded by Matthias Allred - [email protected] IP 50.225.25.74

This audit trail report provides a detailed record of the online activity and events recorded for this document.

https://skylineinsuranceagency.com/

Audit Trail Serial# 3577cac5077c67110cb829b01d57e983